Embodiments relate to medical devices for surgical wound repair and, in particular, of suturing devices for automatic or semi-automatic application of sutures.
Currently the repair of long wounds is performed by the hand of a trained medical professional, often a surgeon. For both surgically or traumatically created full thickness wounds of the skin and subcutaneous tissues this involves the layered repair of the subcutaneous portion (fat, superficial fascia, and deep dermis) of the wound as one layer and the upper dermis and epidermis as a second layer. This is typically performed with single interrupted buried resorbable sutures followed by either a continuous running subcuticular resorbable (more superficial dermal) suture, a through-and-through interrupted suture nonabsorbable suture, or a continuous running suture similar to a baseball stitch which is also dermal and epidermal.
This process can be quite time consuming when treating long wounds, similar to those required in plastic surgery and body lifts. In practice, for each stitch or throw, a needle driver is typically required. During this process the suturing professional clamps the needle distally, towards the non-pointed end, with the needle driver, then drives or pushes the pointed end through the medium following its natural curved path until the needle point emerges. Finally, the professional unclamps the needle, and re-clamps it proximally, towards the pointed end, pulling it the rest of the way through the material or flesh. The technique requires one hand with a forcep to control the tissue and the second hand to control the needle driver, each motion adding time to the procedure, even with an assistant retracting tissue or cutting suture for the primary surgeon. In trauma or veterinarian applications the complexities of applying sutures to a wound in general and long wounds in particular are exacerbated by the usual absence of a controlled surgical environment. Longer operating times are associated with higher complication rates from both the anesthetic as well as higher risks of wound infection. Therefore, a mechanism which can improve the efficiency of motion and reduce operative times can improve outcomes.
Inventions found in the prior art have tried to mitigate this issue by automating the suturing process. However, they have found limited success. Particularly, disclosures in the prior art have focused on using curved needles that are actuated by friction. This solution is bulky and often presents performance problems when the movement of the needle through the medium is impeded by higher densities and thicknesses. In those situations, the lack of friction between the needle and the driving wheels causes the needle to get stuck. Additionally, these technologies inherently lack precise needle control because of traction loss between the driving wheels and the smooth metal needle.
Other approaches have focused on operating the needle with a pushing system based on a pawl that engages the needle. However, these systems can only rotate the needle in one direction and in predetermined steps before the pawl must be reset to reengage the needle. In addition, these systems are all hand operated devices that constantly require user input and cannot operate automatically.
Therefore, in emergency, in-the-field trauma, and planned surgeries, both in human and veterinarian applications, the benefits of semi-automatic and automatic operation of a suturing device that can provide controlled angular rotation of the needle accrue resulting in a simpler, more accurate and more efficient process for the medical professional translating to better, faster and safer patient care.